25
Diabetes Management
Î For selected individual patients, such as those with a short duration
of diabetes mellitus and a long life expectancy, a goal hemoglobin A1c
(HbA1c) of ≤7% is reasonable. (IIa-B)
Î A goal HbA1c between 7% and 9% is reasonable for certain patients
according to age, history of hypoglycemia, presence of microvascular
or macrovascular complications, or presence of coexisting medical
conditions. (IIa-C)
Î Initiation of pharmacotherapy interventions to achieve target HbA1c
might be reasonable. (IIb-A)
Î Therapy with rosiglitazone should NOT be initiated in patients with
SIHD. (III-C: Harm)
Physical Activity
Î For all patients, the clinician should encourage 30-60 minutes of
moderate-intensity aerobic activity, such as brisk walking, at least
5 days and preferably 7 days per week, supplemented by an increase
in daily lifestyle activities (eg, walking breaks at work, gardening,
household work) to improve cardiorespiratory fitness and move
patients out of the least-fit, least-active, high-risk cohort (bottom
20%). (I-B)
Î For all patients, risk assessment with a physical activity history and/or
an exercise test is recommended to guide prognosis and prescription.
(I-B)
Î Medically supervised programs (cardiac rehabilitation) and physician-
directed, home-based programs are recommended for at-risk patients
at first diagnosis. (I-A)
Î It is reasonable for the clinician to recommend complementary
resistance training at least 2 days per week. (IIa-C)
Weight Management
Î BMI and/or waist circumference should be assessed at every visit,
and the clinician should consistently encourage weight maintenance
or reduction through an appropriate balance of lifestyle physical
activity, structured exercise, caloric intake, and formal behavioral
programs when indicated to maintain or achieve a BMI between
18.5 and 24.9 kg/m
2
and a waist circumference <102 cm (40 inches)
in men and <88 cm (35 inches) in women (less for certain racial
groups). (I-B)
Î The initial goal of weight loss therapy should be to reduce body weight
by ~5% to 10% from baseline. With success, further weight loss can
be attempted if indicated. (I-C)
